Rakesh C. Gupta

Traumatic pulmonary pseudocyst.

Blunt thoracic trauma manifests in various ways, depending on the structures injured and type of injury. Commonly manifested as parenchymal contusion, at times, pseudacavitation may also been seen on the chest X ray. They are to be differentiated from other causes of pulmonary cavitations which are often done based on history. The so called pulmonary pseudo cysts usually have a benign course and needs only observation.

Clinical profile of patients having pulmonary tuberculosis and renal amyloidosis.

Objectives: This study was planned to define the clinical profile of pulmonary tuberculosis (PTB) patients having renal amyloidosis, to identify the factors responsible for development of amyloidosis, to detect the time period between onset of amyloidosis and PTB, and analyze clinical features of amyloidosis in PTB patients for early diagnosis and timely assessment. Materials and Methods: Patients of PTB having pedal edema, proteinuria, and grossly diseased kidneys on ultrasound abdomen were subjected to renal biopsy and appropriate biochemical investigations. Clinical profile of biopsy proven amyloidosis cases was analyzed. Results: There were 43 patients (32 males, 11 females, age range 20–65 years) having PTB with pedal edema, proteinuria, and renal medical disease on abdominal ultrasound where amyloidosis was confirmed by renal biopsy. The total duration of illness ranged from two months to seven years (mean 2.25 years) and was less than five years in 93% patients. All patients had significant proteinuria. Nephrotic syndrome was seen in 23, hypertension in 19, hypoalbuminemia in 33, hypercholesterolemia in 29, and deranged renal functions in 32 patients. Ninety percent patients had moderate to far advanced pulmonary lesions on chest radiography with smear positivity in 21 patients. Conclusions: Renal amyloidosis is an important complication of PTB and should be suspected clinically in patients presenting with a triad of pedal edema, proteinuria, and medical renal disease on ultrasound. Contrary to general belief, renal amyloidosis may occur in PTB patients having disease for relatively shorter duration, and even if adequately treated.

Non-small cell lung carcinoma presenting as carcinomatous meningitis

Meningeal carcinomatosis is a diffuse infiltration of leptomeninges and sub arachnoid space by malignant cells metastasizing from systemic cancer. Primary bronchogenic carcinoma presenting as carcinomatous meningitis is a very rare occurrence in clinical practice, often occurring during the treatment course of the underlying malignancy. We present this rare presentation in a young non-smoker male.

Myelomatous pleural effusion ‐ Thoracoscopic evaluation of a rare entity

Multiple myeloma is a malignant neoplasm of plasma cell origin that mainly affects bone marrow and skeletal system, producing large amount of light chain immunoglobulins. Pleural involvement in multiple myeloma is a rare complication which carries very poor prognosis. We report a case of multiple myeloma who presented with recurrent pleural effusion that was evaluated by means of thoracoscopy.

A case of pulmonary carcinoid tumor with concomitant tuberculosis

The simultaneous occurrence of pulmonary carcinoid tumor and tuberculosis is very rare. A case of pulmonary carcinoid tumor is described in a 35-year-old male patient who had concomitant ipsilateral pulmonary tuberculosis. The importance of dual pathological diagnosis in clinical practice is also emphasized.

Carcinoma breast related metastatic pleural effusion: A thoracoscopic approach

Background: Pleural effusions are common and devastating complication of advanced malignancies. Lung and breast cancers cause approximately 75% of all malignant pleural effusions. Pleural effusions associated with carcinoma breast (either malignant or paramalignant) pose diagnostic and therapeutic dilemmas for the treating chest physician. Materials and Methods: In a prospective study of analysis of unexplained pleural effusions, we performed medical thoracoscopy in 9 cases of carcinoma breast between April 2011 and September 2014. All the relevant clinical and paraclinical were collected and analyzed. Results: Sole pleural effusion was the most common radiological finding. This article reviews 9 cases of carcinoma breast patients, who had developed recurrent lymphocytic exudative pleural effusion, within a year of diagnosis. Thoracoscopy was diagnostic in all 9 cases with a histological diagnosis of metastatic carcinoma arising from the breast. Surprisingly malignant cells were negative in pleural fluid of all cases on three consecutive occasions. Conclusion: Carcinoma breast related pleural effusion is a common condition encountered in respiratory medicine and oncology. Thoracoscopic guided pleural biopsy is an effective and safe technique in patients with undiagnosed pleural effusion. It not only gives an accurate diagnosis but also gives a high degree of relationship between thoracoscopic appearance and primary disease or tumor classification.

Diagnostic evaluation of mediastinal lesions: Analysis of 144 cases

Background: Mediastinum is a “Pandoras box” with many neoplastic and nonneoplastic lesions. The purpose of this study was to analyze our institutional experience of mediastinal lesions on fine-needle aspiration cytology (FNAC) and/or biopsy. Materials and Methods: This study was an analysis of 144 patients who had undergone ultrasound-guided FNAC and/or core biopsy for mediastinal lesions. Results: A total of 144 cases of suspected mediastinal masses were seen, and in 139 cases, tissue diagnosis was attempted. Out of 139 cases, 93 cases were neoplastic in nature (67%), 32 were nonneoplastic (23%), and 14 remained inconclusive (10%). Among neoplastic mediastinal lesions, metastatic carcinoma (37.4%) was the most common neoplastic lesion, followed by non-Hodgkins lymphoma (12.2%), Hodgkins lymphoma (7.1%), thymic lesions (3.5%), etc. Among nonneoplastic conditions, tuberculosis was the most common lesion (20.1%). An accurate tissue diagnosis was made in 89.9% cases by FNAC or core biopsy of mediastinal lesions in this study. Procedure-related mortality was nil. Complications were mostly minor and included chest pain in 24.5%, small pneumothorax in 13.6% requiring closed tube thoracostomy in 1.4%, and scanty hemoptysis in 9.3% cases. Conclusion: Neoplastic mediastinal lesions are more common than nonneoplastic lesions, with metastatic carcinoma being the most common cause followed by tuberculosis. A wide variety of lesions observed in this study stress on the importance of cytohistological diagnosis in all cases of mediastinal lesions for the final diagnosis and management planning. A guided FNAC or core biopsy is still accurate, well tolerated, and devoid of major complications.

Thoracoscopic evaluation of 129 cases having undiagnosed exudative pleural effusions.

Background: Medical thoracoscopy is a minimally invasive procedure used in diagnostic and therapeutic applications for pleural diseases. In this study, we describe our experience in the outcome and analysis of thoracoscopy in undiagnosed pleural effusion presenting to our center. Materials and Methods: This is a prospective study conducted over last 2 years. We performed thoracoscopy in 129 cases of undiagnosed exudative pleural effusions using rigid thoracoscope. Clinical, radiological, cyto and histopathological data of the patients were collected prospectively and analyzed. Results: The overall diagnostic yield of thoracoscopic pleural biopsy was 110/129 (85.2%) in patients with undiagnosed pleural effusion, and 19/129 (14.8%) patients remained unexplained. Histopathological diagnosis confirmed malignancy in 66.4% patients (both primary and metastatic pleural carcinoma), tuberculosis in 28.2%, others including parapneumonic effusion in 4 cases followed by multiple myeloma, lupus pleuritis, and pulmonary langerhans cell histiocytosis in one case each. Procedure-related mortality was nil. Minor complications related to the procedure include hemorrhage, subcutaneous emphysema, etc. Conclusion: Thoracoscopy is relatively a safe and well-tolerated procedure with high diagnostic accuracy in undiagnosed pleural effusions, decreasing the need of formal diagnostic thoracotomy. Every chest physician must, therefore, consider this procedure to decrease the time lag in achieving the final diagnosis and to initiate the treatment as early as possible.

Peripheral neuropathy in Chronic Obstructive Airway Disease

Peripheral neuropathy in COPD has received scanty attention despite the fact that very often clinicians come across COPD patients having clinical features suggestive of peripheral neuropathy while this comorbidity is often overlooked & considered a separate entity. A number of studies have now confirmed the association of COPD and peripheral neuropathy with hypoxaemia being a dominant etiopathogenic factor among others. We report a case a demyelinating polyradiculopathy in a patient with COPD along with a brief review of literature.

Consolidation in a Child from Tuberculosis Endemic Area - Thinking Apart from Tuberculosis.

Tuberculosis is endemic in South East Asian regions and hence a disease commonly over diagnosed in these parts of the country. Patients presenting with chest x ray shadows and vague symptoms are often started on Anti Tuberculosis Treatment - smear negative. However caution should be administered in prescribing ATT to patients who do not improve symptomatically, even after intensive phase. Congenital abnormalities such as sequestrated lung at times can also be rare causes of abnormal skiagram chest, especially in paediatric patients. A careful systematic approach with non invasive imaging such as CECT chest will often help to clinch the diagnosis in most cases.